Patient Safety: Lessons Learned
Listening To Your Patient Is Essential

By: Steve Chinn, DPM, MS, MBA, Director, Accreditation, Quality & Patient Safety

This story comes straight from the risk management files. A patient injured in a motor vehicle accident had a four-hour hip surgery that required the use of a perineal post pad between his legs, with traction. On post-op day two, he complained of scrotal pain, swelling and bruising. The pain was considerably greater in the scrotum than in the hip or legs. He asked to see an urologist, but the primary medical team told him and the nursing staff to apply ice and the edema should go away on its own. Throughout the day, however, he continued to report scrotal pain and asked again to see an urologist. He was upset and did not feel his concerns were being addressed.

He was discharged with instructions to follow up with the orthopedic clinic in several weeks. On his own, he went to see an urologist and a plastic surgeon less than two weeks after surgery. He was diagnosed with partial thickness perineal necrosis, which required surgical debridement, and increased the length of his recovery. Unfortunately, this patient was injured, and we did not adequately address his concerns. As a result, he filed a notice of intent to sue.

For the patient, the additional morbidity might have been preventable. For the physician, the additional stress and time commitment resulting from the risk management/legal intervention might have been avoided.

Listen to the patient 

Nursing staff and house staff should escalate issues to attending physicians when patients feel their concerns are not being addressed. Over the years, studies have shown that the better the patient experience and the sooner patients' concerns are addressed, the lower the likelihood of a lawsuit.

Simply listening to the patient's request in this case might have improved his clinical outcome and might have avoided the intent to sue. But in many cases, patients are heard but staff members do not know what to do. If you need help managing a patient's concerns or complaints, resources are available through Guest Services or Risk Management. Both are accessible by calling the hospital operator.

Responding to patients' and/or staff concerns is considered "standard work," a concept promoted by the Stanford Operating System (SOS). Under the SOS, this standard is no different than making sure you document a daily progress note, sign off your orders or examine the patient before you prescribe any medications. Safe patient care = no patient harm. Safe patient care is part of quality care. Thank you for doing your part!

If you have a patient safety story to share or questions about Stanford Hospital & Clinics' Patient Safety program, contact Dr. Steve Chinn at sdchinn@stanfordmed.org.